Should Children Have Their Tonsils Removed?

Danish researchers followed nearly 1.2 million children for up to 21 years. Five percent had their tonsils or adenoids removed by age nine.

• Children who had their tonsils removed had three times the risk for upper respiratory tract diseases afterwards.

• Children who had their adenoids removed had double the risk for infections, chronic obstructive pulmonary disease and eye infections.

• Children who had both their tonsils and adenoids removed also had increased risk for allergies, while the long-term benefits were considered "minor" (JAMA Otolaryngology—Head and Neck Surgery, June 7, 2018).

An earlier study showed increased risk for upper respiratory infections in children followed for 20 years after they had their tonsils removed (Int J Pediatr Otorhinolaryngol, Sept 2003;67(9):981-8). The Infectious Disease Society of America and the American Academy of Pediatrics have reported that removing tonsils or adenoids have not been shown to cure middle ear infections and should be done only for extreme and frequent strep throat infections that do not respond to other treatments. In spite of this data, many doctors still feel that tonsillectomies can help reduce childhood throat infections (Pediatr Clin North Am, 2013;60(4):793-807).

Possible Explanation for Increased Infection Rate Doctors perform almost 400,000 tonsillectomies yearly in the United States. They usually remove tonsils and adenoids in young children for recurrent tonsil or ear infections or sleep apnea. However, tonsils and adenoids produce cells and cytokines that kill germs (Otolaryngol Head Neck Surg, 2011;144(1)(suppl):S1-S30) and removing them at a young age may decrease children's ability to protect themselves from respiratory infections in their adult years (Proc Biol Sci, 2015;282(1821):20143085).

A similar result could occur when surgeons remove the appendix whenever they operate on a person's belly, just "to prevent appendicitis". A healthy appendix should never be removed just because it is there. Your appendix may help to protect you from disease by storing healthful bacteria. The appendix has far more lymphoid tissue than the rest of the first part of the colon (Nature Immunology, 2016;17:179–186). The lymphatic tissue in the appendix is different from lymphatic tissue in other parts of your gut in that it may stimulate your immunity to grow beneficial healthful bacteria. It serves as a safe storage area that can help to replenish your colon with beneficial bacteria to replace those that are lost when you take a course of antibiotics or when harmful bacteria invade your colon and cause diarrhea.

Swedish researchers reported that having tonsils or the appendix removed before age 20 is associated with increased risk for heart attacks by 44 percent for the tonsils and 33 percent for the appendix (Eur Heart J, 2011;32(18):2290-2296). The authors feel that removing tonsils of young people may damage the immune system to increase inflammation that can damage the heart. A review of 23 studies shows that nine percent of children undergoing a tonsillectomy to treat sleep apnea were five times more likely than those with other problems to suffer breathing problems (Pediatrics, Sept 21, 2015). Children who had their tonsils removed may be at increased risk for inflammatory bowel disease (Int J Pediatr Otorhinolaryngol, 2003;67(9):981-988).

Reasons for Removing Tonsils The most common reason that some doctors recommend removing tonsils is for sore throats that recur more than five times a year, although many doctors disagree. Several articles support treating sleep apnea related to enlarged tonsils that can cause poor school performance or daytime sleepiness, but other articles show little, if any, benefit (Otolaryngol Head Neck Surg, 2009;140(6):800-808). Sleep apnea causes a person to stop breathing for short periods, which can drop blood oxygen levels low enough to damage the brain. About one percent of children suffer from obstructive sleep apnea, with symptoms including loud snoring, daytime sleepiness and lack of attention in school. Other reasons for removing tonsils include abscesses, cancer or a suspicious lesion around the tonsils, or tonsils so large that they interfere with sleeping, swallowing or breathing.

My Recommendations There are legitimate reasons for removing tonsils, adenoids or the appendix, but you should be informed about potential side effects. If your child's doctor recommends this type of surgery, discuss the reasons, benefits and possible side effects with him or her.

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